Robotic surgical system with mechanomyography feedback

Abstract

A robotic surgical system for performing a surgical procedure within the body of a subject includes an elongate surgical instrument, a robotic controller configured to control the motion of the distal end portion of the surgical instrument, and a mechanomyography feedback system in communication with the robotic controller. The mechanomyography feedback system includes a mechanical sensor configured to monitor a physical motion of a muscle and to provide a mechanomyography signal corresponding to the monitored physical motion. Additionally, the feedback system includes a processor configured to receive the mechanomyography signal, to determine if the received signal is indicative of an induced muscle response, and to provide a control signal to the robotic controller if an induced muscle response is detected.

The invention claimed is: 
     
       1. A robotic surgical system for performing a surgical procedure within the body of a subject, the robotic surgical system comprising:
 an elongate surgical instrument having a proximal end portion and a distal end portion; 
 a robotic controller configured to control the motion of the distal end portion of the surgical instrument; and 
 a mechanomyography feedback system in communication with the robotic controller, the mechanomyography feedback system including:
 a mechanical sensor configured to:
 monitor a physical motion of a muscle; and 
 provide a mechanomyography signal corresponding to the monitored physical motion; and 
 
 a processor configured to:
 receive the mechanomyography signal; 
 determine if the received mechanomyography signal is indicative of an induced muscle response; and 
 provide a control signal to the robotic controller if an induced muscle response is detected. 
 
 
 
     
     
       2. The robotic surgical system of  claim 1 , wherein the robotic controller is configured to limit the range of motion of the elongate surgical instrument in response to the received control signal. 
     
     
       3. The robotic surgical system of  claim 1 , wherein the robotic controller is configured to prevent motion of the distal end portion of the surgical instrument in response to the control signal. 
     
     
       4. The robotic surgical system of  claim 1 , wherein the control signal is indicative of a proximity between the distal end portion of the elongate surgical instrument and a nerve. 
     
     
       5. The robotic surgical system of  claim 4 , wherein the robotic controller is configured to vary the speed of the distal end of the elongate surgical instrument as a function of the indicated proximity. 
     
     
       6. The robotic surgical system of  claim 1 , wherein the processor of the mechanomyography feedback system is configured to determine if the received mechanomyography signal is indicative of an induced muscle response by:
 computing a time derivative of acceleration from the received mechanomyography signal; and 
 comparing the computed time derivative of acceleration from the mechanomyography signal to a jerk threshold. 
 
     
     
       7. The robotic surgical system of  claim 1 , wherein the distal end portion of the surgical instrument includes a stimulator configured to provide an electrical stimulus. 
     
     
       8. The robotic surgical system of  claim 7 , wherein an induced muscle response includes physical motion of the muscle attributable to a depolarization of a nerve innervating the muscle; and
 wherein the depolarization of the nerve is induced by the provided electrical stimulus. 
 
     
     
       9. The robotic surgical system of  claim 1 , wherein the elongate surgical instrument includes an end effector disposed at the distal end portion, the end effector being actuatable in at least one degree of freedom;
 wherein the robotic controller is configured to control the actuation of the end effector; and 
 wherein the robotic controller is configured to prevent actuation of the end effector in response to the control signal. 
 
     
     
       10. The robotic surgical system of  claim 1 , wherein the elongate surgical instrument includes an end effector disposed at the distal end portion, the end effector being actuatable in at least one degree of freedom;
 wherein the robotic controller is configured to control the actuation of the end effector; and 
 wherein the robotic controller is configured to actuate the end effector in response to the control signal. 
 
     
     
       11. The robotic surgical system of  claim 1 , further comprising a master station in communication with the robotic controller and configured to:
 receive an input from a user corresponding to an intended movement of the distal end portion of the surgical instrument; and 
 provide a motion command to the robotic controller corresponding to the received input; and 
 wherein the master station is configured to provide at least one of a visual alert and auditory alert if an induced muscle response is detected. 
 
     
     
       12. A method of nerve avoidance during robotically assisted surgery comprising:
 controlling the motion of a distal end portion of an elongate surgical instrument using a robotic controller; 
 receiving a mechanomyography signal from at least one mechanical sensor; 
 determining if the received mechanomyography signal is indicative of an induced muscle response; and 
 providing a control signal to the robotic controller if an induced muscle response is detected. 
 
     
     
       13. The method of  claim 11 , further comprising electronically limiting the range of motion of the distal end portion of the elongate surgical instrument in response to the received control signal. 
     
     
       14. The method of  claim 11 , further comprising preventing, via the robotic controller, motion of the distal end portion of the surgical instrument in response to the control signal. 
     
     
       15. The method of  claim 11 , wherein the control signal is indicative of a proximity between the distal end portion of the elongate surgical instrument and a nerve. 
     
     
       16. The method of  claim 14 , further comprising varying the speed of the distal end portion of the elongate surgical instrument as a function of the indicated proximity. 
     
     
       17. The method of  claim 11 , wherein determining if the received mechanomyography signal is indicative of an induced muscle response includes:
 computing a time derivative of acceleration from the received mechanomyography signal; and 
 comparing the computed time derivative of acceleration from the mechanomyography signal to a jerk threshold. 
 
     
     
       18. The method of  claim 11 , providing an electrical stimulus via a stimulator associated with the distal end portion of the elongate surgical instrument. 
     
     
       19. The method of  claim 11 , further comprising providing at least one of a visual alert and an auditory alert to a user if an induced muscle response is detected. 
     
     
       20. The method of  claim 11 , further comprising:
 monitoring a physical motion of a muscle of a subject using the at least one mechanical sensor; and 
 generating the mechanomyography signal via the at least one mechanical sensor, wherein the mechanomyography signal corresponds to the monitored physical motion.